Drill guide

ABSTRACT

A drill guide includes a body, a stabilizing member, a tubular guide sleeve, and an engagement member. The body includes a first channel aligned with a longitudinal axis and a second channel transverse to the longitudinal axis. The first channel is dimensioned to receive the sleeve, while the second channel is dimensioned to receive an engagement member. The engagement member is adapted to move within the second channel between an engaged position, where the engagement member inhibits proximal motion of the sleeve, and a second position, where motion of the sleeve is not inhibited. An alignment member is further mounted to the distal end of the sleeve that includes a distally extending member, spaced from the sleeve. In use, the distally extending member may be employed to exert a force upon a bone or other tissue lateral to the longitudinal axis for improved positioning of the bone or tissue.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims the benefit of priority of U.S. ProvisionalPatent Application No. 61/940,733, filed on Feb. 17, 2014, entitled“DRILL GUIDE,” the entirety of which is hereby incorporated byreference.

BACKGROUND

Joint and ligament injuries are common. One type of such injuriesincludes acromioclavicular joint disruptions. In treating these jointinjuries, it has been common to utilize woven polyester slings orsurgical screws. The goal of any such treatment is to re-approximatebones, tendons and ligaments back to their anatomical locations tofacilitate the healing process.

SUMMARY

In an embodiment of the disclosure, a drill guide is provided. The drillguide includes a tubular guide sleeve extending along a longitudinalaxis of the drill guide between a proximal end and a distal end and adrill guide body including a proximally-facing surface, adistally-facing surface, and a plurality of lateral surfaces extendingthere-between. The drill guide body further includes: a first channelextending through the guide body between the proximal and distal guidebody surfaces and aligned with the longitudinal axis, the first channeldimensioned to receive the tubular sleeve; and a second channelextending through at least a portion of the guide body and a lateralsurface of the guide body transverse to the longitudinal axis, thesecond channel intersecting the first channel. The drill guide furtherincludes an alignment member attached to the distal end of the sleeve,where the alignment member includes a distally facing surface and anelongate locating member extending distally from the distally facingsurface of the alignment member, where the locating member is laterallyspaced from the longitudinal axis and where a distal end of the locatingmember extends distally beyond the distal tip of the sleeve. The drillguide additionally includes an engagement member dimensioned forplacement within the second channel, where the engagement memberincludes a through-passageway oriented parallel to the first channelwhen the engagement member is positioned within the second channel, thepassageway dimensioned for receipt of a portion of the sleeve therein.The engagement member is further adapted to move within the secondchannel between an engaged position and a disengaged position, where theengagement member inhibits proximal movement of the sleeve in theengaged position, and where the engagement member does not inhibitproximal movement of the sleeve in the disengaged position.

Embodiments of the drill guide may further include one or more of thefollowing, in any combination.

In an embodiment of the drill guide, the second passageway isapproximately perpendicular to the first passageway.

In an embodiment, the drill guide further includes a ratchet mechanism.The ratchet mechanism includes a pawl mounted to the engagement memberand a plurality of teeth mounted to the sleeve, where the pawl engagesthe plurality of teeth in the engaged position of the engagement memberto inhibit proximal motion of the sleeve.

In an embodiment, the drill guide further includes a biasing mechanismpositioned within the second channel, where the biasing mechanism biasesthe engagement member in the engaged position.

In an embodiment, the drill guide further includes a stabilizing member.The stabilizing member includes a first elongated portion extendingdistally from the guide body, where a distal end of the first portion ispositioned distally with respect to the distal end of the sleeve, and asecond elongated portion extending from the distal end of the firstportion and transversely with respect to the longitudinal axis and wherethe second portion of the stabilizing member intersects the longitudinalaxis.

In an embodiment of the drill guide, the locating member extendsapproximately parallel to the sleeve.

In an embodiment of the disclosure, a method of joint repair isprovided. The method includes securing a drill guide body with respectto a patient's anatomy. The drill guide body includes aproximally-facing surface, a distally-facing surface, and a plurality oflateral surfaces extending there-between. The drill guide body furtherincludes: a first channel extending through the guide body between theproximal and distal guide body surfaces and aligned with thelongitudinal axis, the first channel dimensioned to receive a tubulardrill guide sleeve, and a second channel extending through at least aportion of the guide body and a lateral surface of the guide bodytransverse to the longitudinal axis, the second channel intersecting thefirst channel. The drill guide also includes an engagement memberdimensioned for placement within the second channel, the engagementmember including a through-passageway oriented parallel to the firstchannel when the engagement member is positioned within the secondchannel, the passageway dimensioned for receipt of a portion of thedrill guide sleeve therein. The engagement member is adapted to movewithin the second channel between an engaged position and a disengagedposition. The engagement member inhibits proximal movement of the sleevein the engaged position and the engagement member does not inhibitproximal movement of the sleeve in the disengaged position. The methodalso includes positioning the drill guide sleeve within the firstchannel. The drill guide sleeve includes a tubular sleeve body extendingbetween a proximal end and a distal end; and an alignment memberattached to the distal end of the sleeve body. The alignment memberincludes a distally facing surface and an elongate locating memberextending distally from the distally facing surface of the alignmentmember, where the locating member is laterally spaced from thelongitudinal axis and where a distal end of the locating member extendsdistally beyond the distal tip of the sleeve body. The method alsoincludes positioning the drill sleeve guide with respect to a firstbone, including sliding the drill guide sleeve distally such that thedistal end of the sleeve contacts a proximally-facing surface of thefirst bone, where at least a portion of the sleeve remains within thefirst channel of the guide body and where at least a portion of thelocating member contacts a laterally-facing surface of the first bone.

Embodiments of the method may include one or more of the following, inany combination.

In an embodiment, the method further includes distally advancing a drillbit through the drill guide sleeve and drilling a first hole through thefirst bone.

In an embodiment, the method further includes distally advancing thedrill bit into contact with a second bone and drilling a second holethrough the second bone, where the first and second holes are alignedalong the longitudinal axis of the drill guide.

In an embodiment of the method, the first bone is a clavicle of apatient and the second bone is a coracoid process of the patient.

In an embodiment of the method, the drill guide body further includes astabilizing member. The stabilizing member includes a first elongateportion extending distally from the guide body, where a distal end ofthe first portion is positioned distally with respect to the distal endof the sleeve and a second elongate portion extending from the distalend of the first portion and transversely with respect to thelongitudinal axis, where the second portion of the stabilizing memberintersects the longitudinal axis.

In an embodiment of the method, securing the drill guide body to thepatient's anatomy further includes positioning the drill guide body ontop of the patient's shoulder and placing the second portion of thestabilizing member under the patient's scapula.

In an embodiment of the method, the drill guide sleeve is not rotatedwhile positioned within the first channel of the drill guide.

In an embodiment of the method, the drill guide further includes aratchet mechanism. The ratchet mechanism includes a pawl mounted to theengagement member and a plurality of teeth mounted to the sleeve, wherethe pawl engages the plurality of teeth in the engaged position of theengagement member to inhibit proximal motion of the sleeve.

In an embodiment of the method, the drill guide body further includes abiasing mechanism positioned within the second channel, where thebiasing mechanism biases the engagement member in the engaged position.

In an embodiment, the method further includes, after drilling the firstand second holes, removing the drill guide body from the patient'sanatomy while retaining the drill guide sleeve in place.

In an embodiment, the method further includes moving the drill guidesleeve laterally with respect to the longitudinal axis such that thelocating member exerts a lateral force on the clavicle.

In an embodiment of the disclosure, a drill guide is provided. The drillguide includes a tubular guide sleeve extending along a longitudinalaxis of the drill guide between a proximal end and a distal end and adrill guide body including a proximally-facing surface, adistally-facing surface, and a plurality of lateral surfaces extendingthere-between. The drill guide body further includes a first channelextending through the guide body between the proximal and distal guidebody surfaces and aligned with the longitudinal axis, the first channeldimensioned to receive the tubular sleeve, and a second channelextending through at least a portion of the guide body and a lateralsurface of the guide body transverse to the longitudinal axis, thesecond channel intersecting the first channel. The drill guide alsoincludes an engagement member dimensioned for placement within thesecond channel, the engagement member including a through-passagewayoriented parallel to the first channel when the engagement member ispositioned within the second channel, the passageway dimensioned forreceipt of a portion of the sleeve therein. The engagement member isfurther adapted to move linearly within the second channel between anengaged position and a disengaged position, where the engagement memberinhibits proximal movement of the sleeve in the engaged position, andwhere the engagement member does not inhibit proximal movement of thesleeve in the disengaged position.

Embodiments of the drill guide may include one or more of the following,in any combination.

In an embodiment of the drill guide, the engagement member is rotatableto move between the engaged position and the disengaged position. In anembodiment, the drill guide further includes a ratchet mechanism. Theratchet mechanism includes a pawl mounted to the engagement member and aplurality of teeth mounted to the sleeve, where the pawl engages theplurality of teeth in the engaged position of the engagement member toinhibit proximal motion of the sleeve.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages will beapparent from the following more particular description of theembodiments, as illustrated in the accompanying drawings in which likereference characters refer to the same parts throughout the differentviews. The drawings are not necessarily to scale, emphasis instead beingplaced upon illustrating the principles of the embodiments.

FIG. 1 is a perspective view of a surgical fastening device;

FIGS. 2A and 2B are top and side views of a first fastener of thesurgical fastening device;

FIGS. 3A and 3B are top and side views of a second fastener of thesurgical fastening device;

FIGS. 4A-4I illustrate a process for using the surgical fastening deviceof FIG. 1;

FIGS. 5A-5B are schematic illustrations of an embodiment of an improveddrill guide for use in embodiments of the process of FIGS. 4A-4I; (A)side view; (B) opposing side view;

FIGS. 6A-6B are schematic illustrations of an embodiment of the drillguide of FIGS. 5A-5B in a magnified view highlighting the drill guidebody;

FIGS. 7A-7B are schematic illustrations of an engagement mechanism forreversibly securing a guide sleeve of the drill guide; (A) front view;(B) rear view;

FIGS. 8A-8B are schematic illustrations of an embodiment of the drillguide of FIGS. 5A-5B positioned on a patient's clavicle; (A) overall;(B) magnified region of clavicle;

FIGS. 8C-8D are schematic illustrations of an embodiment of the drillguide of FIGS. 5A-5B on a patient's clavicle highlighting use of thedrill guide for positioning the clavicle; and

FIGS. 9A-9B are schematic illustrations of another embodiment of theimproved drill guide.

DETAILED DESCRIPTION

Referring to FIG. 1, a surgical fastening device 100 used, for example,in the repair of complete acromioclavicular joint and coracoclavicularligament disruption in a patient's shoulder, includes a planar firstfastener 102, a curved second fastener 104, a tension suture 106, and alead suture 108.

As illustrated in FIGS. 2A and 2B, the first fastener 102 has anelongate, generally rectangular fastener body 120 having a length, L₁,along a long axis, 112, of the fastener body of, for example, 14 mm, awidth, W₁, of, for example, 4 mm, and a thickness, T₁, of, for example,1.5 mm. However, the exact dimensions of the fastener body 120 may bevaried. For example, the dimensions may be varied to accommodate apatient or procedure. The first fastener body 120 has a planar profilewith a first surface 122 and a second surface 124 that are flat andparallel. The first fastener 102 defines four holes 102 a, 102 b, 102 c,and 102 d. Holes 102 b and 102 c receive suture 106. Alternatively, anycombination of holes 102 a, 102 b, 102 c, and 102 d may receive suture106. The second fastener 104, illustrated in FIGS. 3A and 3B, has anelongate, generally rectangular fastener body 130 having, for example,the same overall length, width, and thickness as fastener 102. Thesecond fastener 104 has long edges 132 a, 132 b, short edges 134 a, 134b, a first surface 136 that is concave, and a second surface 138 that isconvex such that the fastener body 130 has a curved profile when viewedalong a long edge 132 a or 132 b of the fastener body 130. The secondfastener 104 defines four holes 104 a, 104 b, 104 c, and 104 d. Holes104 b, 104 c receive suture 106, and hole 104 a receives suture 108.Alternatively, hole 104 d may receive suture 108. Moreover, anycombination of holes 104 a, 104 b, 104 c, and 104 d may receive suture106.

Tension suture 106 and lead suture 108 may be made of any commonsurgical suture material, including, for example, high-strengthpolyethylene. The tension suture 106 passes through holes 102 b, 102 c,104 b, and 104 c and is tied off with a knot, for example a half-hitchknot 114, that allows the distance between the first fastener 102 andthe second fastener 104 to be adjusted by pulling on the ends of thesuture 106. The half-hitch knot 114 is formed, for example, by foldingthe suture 106 roughly in half to form a bight 140 with two suturelengths 142, 144, passing the suture lengths 142, 144 through the bight140 to form a loop 146, passing the suture lengths 142, 144 through hole102 b, through hole 104 b, back through hole 104 c and hole 102 c, andthen through the loop 146. The half-hitch knot 114, also known as a Niceknot, is closed around the suture 106 and moved up to the first fastener102 by pulling on suture ends 142 a, 144 a. Further pulling on thesuture ends 142 a, 144 a shortens the length of the suture between thefasteners 102, 104, moving the fasteners closer together. Whentightened, the half-hitch knot is preferably located against the firstsurface 122 of the fastener 102, which corresponds to an outer surfaceof the fastener in the assembled device 100 (FIG. 1)

In use, referring to FIGS. 4A-41, in which a shoulder of patient 200 isillustrated with a disrupted acromioclavicular joint 202, a clavicle204, and a coracoid process 206, passages are initially drilled throughthe patient's clavicle 204 and coracoid process 206. In order toestablish the passages, the patient needs to be prepared and a drillingguide secured. FIG. 4A shows a clamp 208 of a drilling guide positionedon top of the patient 200's shoulder. The clamp 208 includes a strap 210used to secure the clamp 208 in place on the top of the patientshoulder. The strap 210 is positioned through a first portal 212 in thefront of the patient 200's shoulder, under the patient's scapula, andthrough a second portal (not shown) in the rear of the patient'sshoulder. Next, as shown in FIG. 4B, a first guide tube 214 of thedrilling guide is inserted through a hole in clamp 208 and through athird portal 216.

Once the drilling guide is in place, passages in the clavicle 204 andthe coracoid process 206 are ready to be formed. FIG. 4C depicts a guidewire 218 (i.e., a drill bit) being inserted through a passage in thefirst guide tube 214. As the guide wire 218 is moved through the thirdportal 216 via the first guide tube 214, it encounters the clavicle 204and is drilled through the clavicle 201 and coracoid process 206. Thefirst guide tube 214 provides the support necessary to drill axiallyaligned passages through the patient's clavicle 204 and coracoid process206. In FIG. 4D, the first guide tube 214 is removed from the clamp 208leaving the guide wire 218 in place. The operator then advances a drill220 over the guide wire 218 (FIG. 4E) to “over-drill” the passagesthrough the clavicle 204 and the coracoid process 206 to form bonepassages each having a diameter that is less than the length, L, of thefirst and second fasteners 102, 104.

After the aligned passages through the patient's clavicle 204 andcoracoid process 206 have been formed, the clamp 208 is removed from thepatient's shoulder, as illustrated in FIG. 4F. However, drill 220 isleft in place. At this point, the patient's shoulder is prepared forinsertion of the surgical fastening device 100. Initially, as shown inFIG. 4G, a fourth portal 222 is created in the patient's shoulder. Next,a shuttling mono-suture 224 is passed through the axially alignedpassages in the patient's clavicle 204 and coracoid process 206 via thedrill 220.

In FIG. 4H, the surgical fastening device 100 is attached to theshuttling mono-suture 224. In particular, the lead suture 108 is passedthrough a loop 226 in the end of the shuttling mono-suture 224. Theshuttling mono-suture 224 is used to pull the surgical fastening device100 into the patient's shoulder through the fourth portal 222. Theshuttling mono-suture 224 pulls the lead suture 108, second fastener104, and tension suture 106 up through the axially aligned passages inthe patient's clavicle 204 and coracoid process 206, with the firstfastener 102 and the half-hitch knot 114 positioned below the coracoidprocess 206 (FIG. 41). Positioning the knot 114 below the coracoidprocess 206 rather than above the clavicle 204 lessons any visibleprotrusion of the surgical fastener on the top of the patient's shoulderand decreases the likelihood of infection.

During passage of the second fastener 104 through the passages in thepatient's clavicle 204 and coracoid process 206, a long axis 112 (FIG.3B) of the second fastener 104 is aligned with a longitudinal axis 228of the passages. After exiting through the passage in the clavicle 204,the operator flips the second fastener 104 using the suture 108. Thesecond fastener 104 is seated on the top surface of the clavicle 204with the long axis 112 of the second fastener 104 roughly transverse toan axis 230 of the clavicle 204, and the concave surface 136 abuttingthe surface of the clavicle 204.

With the first fastener 102 positioned below the coracoid process 206,the second fastener 104 positioned above the clavicle 204, and thesuture 106 extending through the passages in the coracoid process 206and clavicle 204, the coracoclavicular is manually reduced throughapplication of external pressure on the patient's shoulder to reduce thedistance between the patient's coracoid process and clavicle tore-approximate the bones, tendons, and ligaments back to theiranatomical locations.

Next, the operator pulls on the ends 142 a, 144 a of the suture 106 toshorten the length of the suture 106 between the fasteners 102, 104 suchthat the distance between the fasteners 102, 104 conforms to thereduction in the coracoclavicular, with the surface 120 of the firstfastener 102 up against the surface of the coracoid process 206. Theoperator then further reduces the coracoclavicular if desired. After thecoracoclavicular is reduced to the preferred distance, a surgical knotis tied behind the half-hitch knot 114. The shuttling mono-suture 224 isremoved from the patient 200. Finally, the first portal 212, the secondportal (not shown), the third portal 216, and the fourth portal 222 arestitched closed.

The passages formed in the coracoid process 206 and the clavicle 204 aresized to allow passage of the second fastener 104. Relatedly, thecurvature of the second fastener 104 is selected such that the secondfastener 104 can pass through the passages and to match the size andcurvature of the patient's clavicle 204. For the same length fastener,as the curvature of the second fastener 104 increases, the diameter ofthe passages necessarily increases to allow the second fastener 104 topass through the passages. However, it is generally better to keep thediameter of the passages formed in the coracoid process 206 and theclavicle 204 as small as possible to maintain the integrity of thecoracoid process 206 and the clavicle 204. Therefore, depending on thesize of the clavicle 204, there can be a trade-off between the diameterof the passages and the extent to which the curvature of the secondfastener 104 matches that of the clavicle 204. To accommodate differentsized patients, a kit of surgical fastening devices 100 can be providedto the surgeon, with each surgical fastening device 100 including asecond member having a different curvature or varying in other differentoverall dimensions.

Further embodiments of fasteners are discussed in U.S. Pat. No.8,926,661, entitled “Surgical Fastening,” the entirety of which ishereby incorporated by reference.

Another embodiment of the drilling guide for use in combination withembodiments of the surgical fastening device 100 and embodiments of therepair procedure of FIGS. 4A-4I is illustrated in FIGS. 5A-5B and 6A-6B.The drill guide 500 includes a body 502, a stabilizing member or strap504, a tubular guide sleeve or bullet 506, and an engagement member 510.By way of reference, distal and proximal will refer to relativedistances, where distal represents a position closer to the patient thanproximal.

The body 502 includes a proximally-facing surface, a distally-facingsurface, and lateral faces extending there-between. A first channel 600is formed through the body 502, extending between the distally- andproximally-facing surfaces and aligned with a longitudinal axis 512 ofthe drill guide 500. The first channel 600 (FIG. 6A) is dimensioned toreceive the guide sleeve 506, as discussed in greater detail below. Asecond channel 602 is further formed within the body 502, extendingtransversely with respect to the longitudinal axis 512 from a lateralface of the body 502 and terminating therein. In certain embodiments,the second channel 602 may be approximately perpendicular to the secondchannel.

The guide sleeve 506 is generally elongated, enclosing a lumen (notshown) that extends between proximal and distal ends of the sleeve 506.The lumen may be dimensioned to accommodate a wire or drill bit (e.g.,218). The distal terminus of the sleeve 506 may be formed with aplurality of sharp points, for use in engaging bone when the sleeve 506is positioned. The sleeve 506 may further include a plurality of teeth520 on its outer surface for mechanically engaging the engagement member510, as discussed in greater detail below.

The guide sleeve 506 further includes an alignment member 516 positionedat the distal end of the sleeve 506. The alignment member 516 may bemounted to the sleeve 506 or integrally formed with the sleeve 506. Thealignment member 516 may include a distally-facing surface 516A and agenerally elongated locating member or finger 516B. The locating member516B is mounted to the distally-facing surface 516A at a distancelaterally spaced from the guide sleeve 506 and extends distally from thedistally-facing surface 516A. In certain embodiments, the locatingmember 516A may be dimensioned such that its distal terminus extendsdistally beyond the distal terminus of the guide sleeve 506. In furtherembodiments, the distally-facing surface 516A and the locating member516B may be formed at an approximately right-angle. In furtherembodiments, the locating member 516B may be oriented approximatelyparallel to guide sleeve 506 and/or the longitudinal axis 512 of theguide 500.

It may be understood, however, that in alternative embodiments, thelocating member and/or the distally facing surface may be furtheradapted for adjustable placement with respect to the guide sleeve 506and/or the longitudinal axis 512 of the drill guide 500. For example,either or both of the locating member and the distally facing surfacemay include one or more pivot points for adjustment of their positions.Alternatively, or additionally, either one or both of the locatingmember and the distally facing surface may be formed from a plasticallydeformable material for adjustment of their positions.

The stabilizing member 504 is generally elongated, mounted to the guidebody 502 and extending distally there-from. The stabilizing member 504may include a first elongated portion 504A and a second portion 504B.The first stabilizing member portion 504A may extend distally from theguide body 502 and be dimensioned to extend beyond the distal terminusof the guide sleeve 506. In certain embodiments, the first stabilizingmember portion 504A may be curved. The second stabilizing member portion504B may extend transversely from the distal end of the firststabilizing member portion 504A and intersecting the longitudinal axis512. The second stabilizing member portion 504B may further include aplanar portion which functions as a physical barrier or stop for a drillbit traveling through the sleeve 506.

With further reference to FIGS. 6A-6B and 7A-7B, the engagement member510 is illustrated. The engagement member 510 is generally elongate,having a first portion 510A and a second portion 510B. The first portionof the engagement member 510A is dimensioned for receipt and reversiblesliding within the second channel 602. While inserted within the secondchannel 602, the second portion of the engagement member 510B remainsoutside the guide body 502.

The first portion of the engagement member 510A further includes athrough passageway 604 dimensioned to receive a portion of the guidesleeve 506 (e.g., a portion of the sleeve 506 proximal to the alignmentmember 516. When inserted a selected distance within the second channel602 of the guide body 502, the passageway 604 is axially aligned withthe first channel 600.

As illustrated in FIGS. 7A-7B, the engagement member 510 may be actuatedby a user to reversibly slide the engagement member 510 within thesecond channel 602 between an engaged position and a disengagedposition. For example, in the engaged position (FIG. 7A), proximalmovement of the guide sleeve 504 may be inhibited, while distal movementof the guide sleeve 504 may be permitted. Furthermore, in the disengagedposition (FIG. 7B), proximal or distal movement of the guide sleeve 506may be allowed. Beneficially, the constraint provided by the engagementmember 510 may allow a surgeon the confidence of distally advancing thesleeve 506 within the guide body 502 while the engagement member 510 isin the engaged position without concern of accidental proximalretraction of the sleeve 506. Subsequently, placing the engagementmember 510 intentionally in the disengaged position, the surgeon mayremove the guide sleeve 506 from the drill guide body 502.

In certain embodiments, the constraint provided in the engaged positionmay be achieved by a ratcheting mechanism formed within the engagementmember 510 and the guide sleeve 506. For example, with further referenceto FIGS. 7A, 7B, the ratcheting mechanism includes a pawl 700 mounted tothe engagement member 510 and the teeth 520 of the guide 506. In theengaged position (e.g., the pawl 700 engages the teeth 502 of the guidesleeve 506 (FIG. 7A). As a result, proximal motion of the guide sleeve506 is inhibited, while distal motion of the guide sleeve 506 isallowed. Sliding the engagement member 510 within the second channel 602such that the pawl 700 does not engage the teeth 502 moves theengagement member 510 into the disengaged position (FIG. 7B). As aresult, the guide sleeve 506 is free to move either proximally ordistally.

The engagement member 510 may be further biased in the engaged positionin order to decrease the likelihood that it is positioned in thedisengaged position accidentally. For example, a biasing member 702 maybe positioned within the second channel 602. The biasing member 702exerts a biasing force upon the engagement member 510, urging theengagement member 510 into the engaged position absent actuation by theuser in a direction opposite this bias. In an embodiment, the biasingmember 702 may be a spring. However, other biasing mechanisms may beemployed without limit.

In order to limit travel of the engagement member 510 within the secondchannel 602 between the engaged and disengaged positions, the drillguide 500 may further include a limiting mechanism. For example, thelimiting mechanism may include a pin 704 extending outward from theengagement member 510 and a slot 706 formed in the second channel 602.Travel of the engagement member 510 within the second channel 602 may belimited within the length of the slot 706. For example, when in theengaged position, the pin 702 may abut one end of the slot 704, while inthe disengaged position, the pin 702 may abut the opposing end of theslot 704. Beneficially, with this configuration, the engagement member510 is inhibited from contacting the guide sleeve 506 with sufficientforce to damage any of the ratchet mechanism, the guide sleeve 506, orthe engagement member 510.

The discussion will now turn to FIGS. 8A-8D, which illustratepositioning of the drill guide 500 in a surgical operation. The drillguide 500 may generally be employed in a surgical operation to repair adisrupted acromioclavicular joint 202, including a clavicle 204 and acoracoid process 206, as discussed above with respect to FIGS. 4A-4I.For example, as illustrated in FIG. 8A, the drill guide body 502 ispositioned on top of the patient's shoulder 200, where the stabilizingmember 504 is used to secure the drill guide body 502 in place. Thestabilizing member 504 may be positioned through the first portal 212 inthe front of the patient's shoulder 200, under the patient's scapula,and through a second portal (not shown) in the rear of the patient'sshoulder. Next, the guide sleeve 506 of the drill guide 500 is insertedthrough the first channel 600 in the guide body 502, and through thethird portal 216. The sleeve 506 is advanced distally (e.g., with theengagement member 510 in the engaged position) such that the distal endof the guide sleeve 506 contacts a proximally facing surface of theclavicle 204.

Notably, in addition to the operations discussed above with respect toFIGS. 4A-41, the drill guide 500 may also be positioned such that thealignment member 516 abuts the clavicle 204. For example, the distal endof the sleeve 506 may be advanced distally to contact a position on theproximally-facing surface of the clavicle 204 such that at least aportion of the locating member 516B contacts a laterally-facing surfaceof the clavicle 216. In this position, the alignment member 516 may bemoved laterally with respect to the longitudinal axis 512 such that thelocating member 516B exerts a lateral force on the clavicle 204.Beneficially, application of such lateral forces may allow the clavicle204 and/or the acromioclavicular joint 202 to be repositioned in anarrangement more suitable for repair, as illustrated in FIGS. 8C-8D.

While discussed above with respect to AC joint repair, it may beunderstood that embodiments of the drill guide 500 may be employed inother joint and/or bone repair procedures as well.

In alternative embodiments, a drill guide 500′ may be provided, asillustrated in FIGS. 9A-9B. The guide 500′ is identical to guide 500except that the alignment member 516 is omitted from the sleeve 506.This configuration may be advantageous for use in joint repairs where itdesirable to proximally retract the guide sleeve 506 from the guide body502 after use (e.g., after contact with joint 202). Notably, injuredjoints can be particularly susceptible to destabilization due to forcesapplied during repair operations. However, the ability to withdraw theguide sleeve 506 of guide 500′ from a joint space without rotating ortransversely sliding the guide sleeve 506 can mitigate this issue.

The terms comprise, include, and/or plural forms of each are open endedand include the listed parts and can include additional parts that arenot listed. And/or is open ended and includes one or more of the listedparts and combinations of the listed parts.

One skilled in the art will realize the invention may be embodied inother specific forms without departing from the spirit or essentialcharacteristics thereof. The foregoing embodiments are therefore to beconsidered in all respects illustrative rather than limiting of theinvention described herein. Scope of the invention is thus indicated bythe appended claims, rather than by the foregoing description, and allchanges that come within the meaning and range of equivalency of theclaims are therefore intended to be embraced therein.

What is claimed is:
 1. A drill guide, comprising: a tubular guide sleeveextending along a longitudinal axis of the drill guide between aproximal end and a distal end; a drill guide body including aproximally-facing surface, a distally-facing surface, and a plurality oflateral surfaces extending there-between, the drill guide body furtherincluding: a first channel extending through the guide body between theproximal and distal guide body surfaces and aligned with thelongitudinal axis, the first channel dimensioned to receive the tubularsleeve; and a second channel extending through at least a portion of theguide body and a lateral surface of the guide body transverse to thelongitudinal axis, the second channel intersecting the first channel; analignment member attached to the distal end of the sleeve, the alignmentmember including: a distally facing surface; and an elongated locatingmember extending distally from the distally facing surface of thealignment member, wherein the locating member is laterally spaced fromthe longitudinal axis and wherein a distal end of the locating memberextends distally beyond the distal tip of the sleeve; an engagementmember dimensioned for placement within the second channel, theengagement member including a through-passageway oriented parallel tothe first channel when the engagement member is positioned within thesecond channel, the passageway dimensioned for receipt of a portion ofthe sleeve therein; the engagement member being further adapted to movewithin the second channel between an engaged position and a disengagedposition, wherein the engagement member inhibits proximal movement ofthe sleeve in the engaged position, and wherein the engagement memberdoes not inhibit proximal movement of the sleeve in the disengagedposition.
 2. The drill guide of claim 1, wherein the second passagewayis approximately perpendicular to the first passageway.
 3. The drillguide of claim 1, further comprising a ratchet mechanism including: apawl mounted to the engagement member; and a plurality of teeth mountedto the sleeve; wherein the pawl engages the plurality of teeth in theengaged position of the engagement member to inhibit proximal motion ofthe sleeve.
 4. The drill guide of claim 1, further comprising a biasingmechanism positioned within the second channel, wherein the biasingmechanism biases the engagement member in the engaged position.
 5. Thedrill guide of claim 1, further comprising a stabilizing memberincluding: a first elongated portion extending distally from the guidebody, wherein a distal end of the first portion is positioned distallywith respect to the distal end of the sleeve; and a second elongatedportion extending from the distal end of the first portion andtransversely with respect to the longitudinal axis; wherein the secondportion of the stabilizing member intersects the longitudinal axis. 6.The drill guide of claim 1, wherein the locating member extendsapproximately parallel to the sleeve.
 7. A method of joint repair,comprising: securing a drill guide body with respect to a patient'sanatomy, the drill guide body comprising: a proximally-facing surface, adistally-facing surface, and a plurality of lateral surfaces extendingthere-between, the drill guide body further including: a first channelextending through the guide body between the proximal and distal guidebody surfaces and aligned with the longitudinal axis, the first channeldimensioned to receive a tubular drill guide sleeve; and a secondchannel extending through at least a portion of the guide body and alateral surface of the guide body transverse to the longitudinal axis,the second channel intersecting the first channel; an engagement memberdimensioned for placement within the second channel, the engagementmember including a through-passageway oriented parallel to the firstchannel when the engagement member is positioned within the secondchannel, the passageway dimensioned for receipt of a portion of thedrill guide sleeve therein; wherein the engagement member is adapted tomove within the second channel between an engaged position and adisengaged position, wherein the engagement member inhibits proximalmovement of the sleeve in the engaged position, and wherein theengagement member does not inhibit proximal movement of the sleeve inthe disengaged position; positioning the drill guide sleeve within thefirst channel, wherein the drill guide sleeve comprises: a tubularsleeve body extending between a proximal end and a distal end; and analignment member attached to the distal end of the sleeve body, thealignment member including: a distally facing surface; and an elongatedlocating member extending distally from the distally facing surface ofthe alignment member, wherein the locating member is laterally spacedfrom the longitudinal axis and wherein a distal end of the locatingmember extends distally beyond the distal tip of the sleeve body;positioning the drill sleeve guide with respect to a first bone,comprising: sliding the drill guide sleeve distally such that the distalend of the sleeve contacts a proximally-facing surface of the firstbone, wherein at least a portion of the sleeve remains within the firstchannel of the guide body and wherein at least a portion of the locatingmember contacts a laterally-facing surface of the first bone.
 8. Themethod of claim 7, further comprising: distally advancing a drill bitthrough the drill guide sleeve; and drilling a first hole through thefirst bone.
 9. The method of claim 8, further comprising: distallyadvancing the drill bit into contact with a second bone; and drilling asecond hole through the second bone; wherein the first and second holesare aligned along the longitudinal axis of the drill guide.
 10. Themethod of claim 9, wherein the first bone is a clavicle of a patient andthe second bone is a coracoid process of the patient.
 11. The method ofclaim 10, wherein the drill guide body further comprises a stabilizingmember including: a first elongated portion extending distally from theguide body, wherein a distal end of the first portion is positioneddistally with respect to the distal end of the sleeve; and a secondelongated portion extending from the distal end of the first portion andtransversely with respect to the longitudinal axis; wherein the secondportion of the stabilizing member intersects the longitudinal axis. 12.The method of claim 11, wherein securing the drill guide body to thepatient's anatomy further comprises: positioning the drill guide body ontop of the patient's shoulder; and placing the second portion of thestabilizing member under the patient's scapula.
 13. The method of claim7, wherein the drill guide sleeve is not rotated while positioned withinthe first channel of the drill guide.
 14. The method of claim 7, whereinthe drill guide further comprises a ratchet mechanism including: a pawlmounted to the engagement member; and a plurality of teeth mounted tothe sleeve; wherein the pawl engages the plurality of teeth in theengaged position of the engagement member to inhibit proximal motion ofthe sleeve.
 15. The method of claim 14, wherein the drill guide bodyfurther comprises a biasing mechanism positioned within the secondchannel, wherein the biasing mechanism biases the engagement member inthe engaged position.
 16. The method of claim 10, further comprising,after drilling the first and second holes, removing the drill guide bodyfrom the patient's anatomy while retaining the drill guide sleeve inplace.
 17. The method of claim 7, further comprising moving the drillguide sleeve laterally with respect to the longitudinal axis such thatthe locating member exerts a lateral force on the clavicle.
 18. A drillguide, comprising: a tubular guide sleeve extending along a longitudinalaxis of the drill guide between a proximal end and a distal end; a drillguide body including a proximally-facing surface, a distally-facingsurface, and a plurality of lateral surfaces extending there-between,the drill guide body further including: a first channel extendingthrough the guide body between the proximal and distal guide bodysurfaces and aligned with the longitudinal axis, the first channeldimensioned to receive the tubular sleeve; and a second channelextending through at least a portion of the guide body and a lateralsurface of the guide body transverse to the longitudinal axis, thesecond channel intersecting the first channel; an engagement memberdimensioned for placement within the second channel, the engagementmember including a through-passageway oriented parallel to the firstchannel when the engagement member is positioned within the secondchannel, the passageway dimensioned for receipt of a portion of thesleeve therein; the engagement member being further adapted to movelinearly within the second channel between an engaged position and adisengaged position, wherein the engagement member inhibits proximalmovement of the sleeve in the engaged position, and wherein theengagement member does not inhibit proximal movement of the sleeve inthe disengaged position.
 19. The drill guide of claim 18, wherein theengagement member is not rotatable to move between the engaged positionand the disengaged position.
 20. The drill guide of claim 18, furthercomprising a ratchet mechanism including: a pawl mounted to theengagement member; and a plurality of teeth mounted to the sleeve;wherein the pawl engages the plurality of teeth in the engaged positionof the engagement member to inhibit proximal motion of the sleeve.